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Dec 17, 2009

Polypoidal choroidal vasculopathy associated with central serous chorioretinopathyA study from Japan finds that patients with polypoidal choroidal vasculopathy (PCV) are more likely to have a history of central serous chorioretinopathy (CSC) and significantly less likely to be diabetic than patients with typical age-related macular degeneration (AMD).

Exudative AMD in the Japanese population is peculiar in that the frequency of polypoidal choroidal vasculopathy (PCV) is significantly higher compared with that in Western populations. Polypoidal choroidal vasculopathy is considered a distinct clinical entity. PCV is more common than typical AMD in the Japanese population. PCV has slower progression, better visual prognosis despite more chronic persistence, better therapeutic response to photodynamic therapy, and is less responsiveness to anti–vascular endothelial growth factor (VEGF) therapy compared with typical AMD.

Methods and Results

Consecutive patients with typical AMD (n = 89) and PCV (n = 138) were recruited. To help confirm a possible association between PCV and central serous chorioretinopathy (CSC), an additionalsurvey was performed. For the secondary survey, the number of participants was extended to include 148 typical AMD and 170 PCV patients. All the patients included in the present study had been followed up at The University of Tokyo Hospital outpatient macular clinic.

Background data on gender; age; body mass index; smoking; alcohol consumption; and medical histories were obtained mainly through interview. The interviewers were masked to the subtype diagnosis of AMD. Univariate and multivariate logistic regression analyses were performed to identify differences in the background factors between typical AMD and PCV. In the secondary survey, the association of a history of central serous chorioretinopathy (CSC) and PCV was confirmed further, and funduscopic findings of an atrophic retinal pigment epithelial (RPE) tract and focal photocoagulation scars that could indicate a history of CSC were investigated.

The 2 groups showed similar backgrounds with the exception of their histories of diabetes mellitus (DM) and CSC. A history of DM was more frequent in typical AMD (24.7% vs. 13.0%; P = 0.027), whereas a history of CSC was more prevalent in PCV (3.4% vs. 14.7%; P = 0.0005). Funduscopic findings of an atrophic RPE tract or focal photocoagulation scars were found more frequently in PCV (0.7% vs. 7.6%; P = 0.002).

Discussion and Conclusions

This study disclosed that typical AMD and PCV resemble one another in demographic, behavioral, cardiovascular, and ocular backgrounds. Both disorders predominantly affect elderly males among Japanese patients. A history of smoking was equally prevalent in both groups. These results indicate that smoking is an important risk factor for PCV as well as typical AMD in the Japanese population.

A history of DM was significantly more frequent in typical AMD (24.7%) than in PCV (13.0%). The reason why a history of DM seems to be associated with the development of typical AMD, and not PCV, is not clear.

A history of CSC also reached statistical significance in the current study. Although it has been known that some patients with CSC later have complications with exudative AMD, the association has been controversial in the literature. These results indicate that PCV has a particularly strong association with a history of CSC.

The investigators conclude that the backgrounds of patients with typical AMD and PCV are similar in most demographic, behavioral, cardiovascular, and ocular factors, but are not identical. Histories of DM and CSC are more common in typical AMD and PCV, respectively, in Japanese patients.